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J Med Case Rep. 2012 Oct 16;6:352. doi: 10.1186/1752-1947-6-352.

Tuberous sclerosis diagnosed by incidental computed tomography findings of multifocal micronodular pneumocyte hyperplasia: a case report.

Journal of medical case reports

Makoto Ishii, Koichiro Asano, Nobufumi Kamiishi, Yuichiro Hayashi, Daisuke Arai, Mizuha Haraguchi, Hiroaki Sugiura, Katsuhiko Naoki, Sadatomo Tasaka, Kenzo Soejima, Koichi Sayama, Tomoko Betsuyaku

Affiliations

  1. Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. [email protected].

PMID: 23072249 PMCID: PMC3512476 DOI: 10.1186/1752-1947-6-352

Abstract

INTRODUCTION: The majority of multifocal micronodular pneumocyte hyperplasia associated with tuberous sclerosis complex is diagnosed with the classical clinical triad of seizures, mental retardation, and skin lesions. We report a rare case of tuberous sclerosis complex with no classical clinical findings, which was diagnosed through incidental computed tomography findings of multiple nodular lesions of multifocal micronodular pneumocyte hyperplasia.

CASE PRESENTATION: A chest computed tomography scan of a 51-year-old Japanese woman showed multiple nodular ground-glass opacities that were not seen on chest X-ray. Video-assisted thoracoscopic surgery was performed. A histological examination demonstrated type II pneumocyte hyperplasia with thickened fibrotic alveolar septa, which was consistent with multifocal micronodular pneumocyte hyperplasia. Brain magnetic resonance imaging displayed multiple cortical tubers, and abdominal computed tomography showed bilateral renal angiomyolipoma. Our patient was finally diagnosed as having tuberous sclerosis complex with multifocal micronodular pneumocyte hyperplasia, although she had no episodes of epilepsy, no skin lesions, and no family history.

CONCLUSIONS: Multifocal micronodular pneumocyte hyperplasia with latent tuberous sclerosis complex should be considered in the differential diagnosis of multiple ground-glass opacities.

References

  1. Chest. 2008 Feb;133(2):507-16 - PubMed
  2. Chest. 1995 Jan;107(1):189-95 - PubMed
  3. J Child Neurol. 1998 Dec;13(12):624-8 - PubMed
  4. Am J Respir Crit Care Med. 2001 Aug 15;164(4):661-8 - PubMed
  5. Am J Hum Genet. 1999 Apr;64(4):986-92 - PubMed
  6. J Child Neurol. 2004 Sep;19(9):680-6 - PubMed
  7. Radiographics. 2008 Nov-Dec;28(7):e32 - PubMed
  8. N Engl J Med. 2006 Sep 28;355(13):1345-56 - PubMed
  9. Histopathology. 2002 Sep;41(3):263-5 - PubMed
  10. Eur J Paediatr Neurol. 2002;6(1):15-23 - PubMed
  11. Am J Surg Pathol. 1998 Apr;22(4):465-72 - PubMed
  12. J Am Acad Dermatol. 2007 Aug;57(2):189-202 - PubMed
  13. Jpn J Clin Oncol. 2008 Jun;38(6):451-4 - PubMed

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